mtDNA Targeted Analysis with Heteroplasmy: Known Familial Variant

Clinical Information

Mitochondrial disorders represent a clinically heterogeneous group of conditions caused by pathogenic variants in either nuclear or mitochondrial DNA (mtDNA). Some mitochondrial disorders affect a single organ while most involve multiple organ systems. Mitochondrial disorders may present at any age and often present with prominent neurologic and myopathic features. Mitochondrial disorders have variable penetrance and severity of symptoms depending on the level of mutant mitochondria, or heteroplasmy, within a given individual or tissue type.

Technical Information

Analysis for a familial variant can be performed using either Sanger sequencing or Next Generation Sequencing (NGS). Sanger sequencing is only able to detect levels of heteroplasmy above 20% while NGS can detect levels as low as 10%. For this reason, Sanger sequencing may be considered as a first step in evaluating for the presence of a familial variant. NGS testing may be reserved for those who appear to be affected or who would be expected to carry the familial variant, but have had negative Sanger sequencing results. As heteroplasmy levels vary from tissue to tissue, a negative blood test cannot completely rule out the chance that an individual carries the familial variant.

Specimen Requirements

• The preferred sample type is 3-4 ml of peripheral blood collected in an EDTA (purple top) tube. Dried blood spots, extracted DNA, and saliva are also accepted for this test. Blood and saliva kits are available by request.
• Approximately 75 µL of blood should be applied to each of the five circles on a filter paper dried blood spot card. Allow blood to dry for at least 4 hours before shipping.
• Send approximately 5 µg of extracted DNA at a requested concentration of 90-130 ng/µl.
• Saliva samples must be submitted in an approved saliva kit.

Transport Instructions

• The blood specimen should be kept at room temperature and delivered via overnight shipping. If shipment is delayed by one or two days, the specimen should be refrigerated and shipped at room temperature. Do not freeze the specimen. Samples collected on Friday can be safely designated for Monday delivery.
• DBS cards should be shipped at room temperature.
• Extracted DNA should be sent at room temperature via overnight delivery.
• Saliva is stable at room temperature and can be delivered via overnight or ground shipping.